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  • Frontiers Media SA  (4)
  • Sun, Tao  (4)
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  • Frontiers Media SA  (4)
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  • 1
    Online Resource
    Online Resource
    Hybrid surgery versus endovascular intervention for patients with chronic internal carotid artery occlusion: A single-center retrospective study
    Frontiers Media SA ; 2022
    In:  Frontiers in Surgery Vol. 9 ( 2022-9-2)
    Details
    In: Frontiers in Surgery, Frontiers Media SA, Vol. 9 ( 2022-9-2)
    Abstract: Chronic internal carotid artery occlusion (CICAO) can cause transient ischemic attack (TIA) and ischemic stroke. Carotid artery stenting (CAS) with embolic protection devices and hybrid surgery combining carotid endarterectomy and endovascular treatment are effective methods for carotid revascularization. The objective of this study was to evaluate and compare the effect and safety of the two surgical procedures. Methods This was a single-center retrospective study. In this study, 44 patients who underwent hybrid surgery and 35 who underwent endovascular intervention (EI) at our center were enrolled consecutively between May 2016 and March 2022. All patients were classified into four groups (A-D), as described by Hasan et al. We recorded and analyzed clinical data, angiographic characteristics, technical success rate, perioperative complications, and follow-up data. Results There was no significant difference in baseline characteristics between hybrid surgery group and EI group, except for plasma high density lipoproteins (HDL) levels (median [interquartile range]: hybrid surgery, 0.99 [0.88–1.18] vs. EI, 0.85 [0.78–0.98] mmol/L, P  = 0.001). The technical success rate of hybrid surgery was higher than that of EI (37/44 [84.1%] vs. 18/35 [51.4%] , P  = 0.002; type A: 15/16 [93.8%] vs. 10/11 [90.9%] , P  = 1.000; type B: 9/10 [90.0%] vs. 5/7 [71.4%] , P  = 0.537; type C: 12/15 [80.0%] vs. 3/12 [25.0%] , P  = 0.004; type D: 1/3 [33.3%] vs. 0/5 [0%] , P  = 0.375). No significant difference was observed in the incidence of perioperative complications between the two procedures (hybrid surgery: 7/44 [15.9%] vs. EI: 6/35 [17.1%] , P  = 0.883). In addition, there were no significant differences in the rates of stroke and restenosis during follow-up. Conclusions For patients with symptomatic CICAO, hybrid surgery may have an advantage over EI in successfully recanalizing occluded segments. There was no significant difference in safety and restenosis between hybrid surgery and EI.
    Type of Medium: Online Resource
    ISSN: 2296-875X
    URL: Article
    DOI: 10.3389/fsurg.2022.976318
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
    detail.hit.zdb_id: 2773823-1
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  • 2
    Online Resource
    Online Resource
    Hybrid Recanalization for the Treatment of Carotid/Vertebral In-stent Restenosis or Occlusion: Pilot Surgery Experiences From One Single Center
    Frontiers Media SA ; 2020
    In:  Frontiers in Neurology Vol. 11 ( 2020-11-24)
    Details
    In: Frontiers in Neurology, Frontiers Media SA, Vol. 11 ( 2020-11-24)
    Abstract: Background : The hybrid recanalization of internal carotid artery (ICA) and vertebral artery (VA) in-stent restenosis or occlusion using a combination of endarterectomy and endovascular intervention has achieved technical success. We present our surgical experiences to further evaluate the safety and efficacy of the hybrid technique for the treatment of in-stent restenosis and occlusion. Methods : A cohort of 12 refractory patients with in-stent restenosis or occlusion who underwent hybrid recanalization, a combination of endarterectomy and endovascular intervention, were retrospectively analyzed. Medical records, including presenting symptoms, comorbidities, contralateral ICA/VA findings, use of antiplatelet drugs, postoperative complications, and angiographic outcomes, were collected. Results : Among 415 consecutive patients with ICA, common carotid artery, and V1 segment lesions, 12 refractory patients (2.89%) with 13 cases were enrolled in our study (1 female and 11 male). All patients underwent successful hybrid recanalization. There were no cases of postoperative stroke or death. Only two patients sustained hoarseness, but it resolved within 2 weeks after surgery. Three patients were treated with dual antiplatelet (aspirin and clopidogrel), seven with single antiplatelet (aspirin), one with single antiplatelet (clopidogrel), and one with single antiplatelet (ticagrelor). All patients were followed up in the outpatient department according to the protocol, with a mean follow-up period of 13 months (range, 6–24 months). No death or recurrent symptoms occurred during the regular follow-up period. Conclusion : The hybrid technique maybe a safe and feasible treatment option to recanalize in-stent restenosis or occlusion with acceptable complications.
    Type of Medium: Online Resource
    ISSN: 1664-2295
    URL: Article
    DOI: 10.3389/fneur.2020.604672
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2020
    detail.hit.zdb_id: 2564214-5
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  • 3
    Online Resource
    Online Resource
    Enlarged Pericarotid Lymph Nodes Suggest Recent Ischemic Symptoms in Patients with Carotid Atherosclerosis
    Frontiers Media SA ; 2022
    In:  Frontiers in Immunology Vol. 13 ( 2022-7-12)
    Details
    In: Frontiers in Immunology, Frontiers Media SA, Vol. 13 ( 2022-7-12)
    Abstract: Atherosclerosis is a chronic inflammatory disease closely associated with immunological activity. Lymph nodes (LNs) are essential secondary lymphoid organs, in which complex immune responses occur. Enlarged LNs are commonly observed around inflamed tissues or tumors; however, their role in atherosclerosis is not well understood. We hypothesized that enlarged pericarotid LNs would be present in symptomatic patients with carotid atherosclerosis. Therefore, we recorded the size of LNs around the carotid artery during surgery in patients undergoing carotid endarterectomy (CEA) for carotid atherosclerotic stenosis. Patients were stratified by enlarged LNs, defined as a diameter ≥ 10mm in the transverse diameters. Demographic and clinical data of participants were measured and analyzed. Hematoxylin and eosin (H & amp;E), Sirius red, DAB-enhanced Perls’ Prussian blue, alizarin red, and immunohistochemistry (IHC) staining were performed for composition identification of plaques or LNs. Symptomatic patients were defined as those presenting with an ipsilateral cerebral ischemic event. Compared with patients with non-enlarged LNs, patients with enlarged LNs were more likely to be symptomatic (22/32, 68.8% versus 9/40, 22.5%, P & lt; 0.001) and use calcium channel blocker drugs (17/32, 53.1% versus 10/40, 25%, P =0.014). In addition, they showed lower body mass index (mean ± SD: 24.00 ± 2.66 versus 25.34 ± 2.56 kg/m 2 , P =0.034), lower weight (median [interquartile range]: 64 [60.00-76.00] versus 72.5 [65.00-77.50] Kg, P = 0.046) and higher diastolic blood pressure (mean ± SD: 78.94 ± 9.30 versus 73.93 ± 8.84 mmHg, P = 0.022). The plague from patients with enlarged LNs exhibited a lower relative percentage of fibrous tissue (29.49 ± 10.73% versus 34.62 ± 10.33%, P = 0.041). The enlarged LNs remained oval-shaped by visual inspection. Compared to non-enlarged LNs, the predominant changes in enlarged LNs were atrophic lymphatic sinuses and dilated LNs parenchyma. Enlarged LNs contained more germinal centers and lymphocytes. In conclusion, symptomatic patients with carotid atherosclerosis have enlarged pericarotid LNs. The current study supports the conclusion that enlarged LNs with an activated and enhanced adaptive immune response may indicate plaque instability. Pericarotid LNs will be a promising marker of plaque stability and may be a potential therapeutic target in patients with carotid atherosclerosis.
    Type of Medium: Online Resource
    ISSN: 1664-3224
    URL: Article
    DOI: 10.3389/fimmu.2022.900642
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
    detail.hit.zdb_id: 2606827-8
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  • 4
    Online Resource
    Online Resource
    Imaging Identification and Prognosis of the Distal Internal Carotid Artery With Near and Complete Occlusion After Recanalization
    Frontiers Media SA ; 2021
    In:  Frontiers in Neurology Vol. 11 ( 2021-2-5)
    Details
    In: Frontiers in Neurology, Frontiers Media SA, Vol. 11 ( 2021-2-5)
    Abstract: Background and Purpose: Previous studies have mainly focused on treatment strategies and clinical outcomes for internal carotid artery near occlusion (ICANO) and internal carotid artery complete occlusion (ICACO). However, reports on the morphological changes of distal internal carotid artery (ICA) after recanalization are scarce. This study aimed at illustrating identifying features, assessing prognosis of the distal ICA after recanalization, and exploring best practices for treatment for ICANO and ICACO. Materials and Methods: We retrospectively studied the clinical characteristics of 57 patients with ICANO or ICACO who underwent surgical recanalization. The clinical data, angiographic morphology, technical successful rate, perioperative complications, and the lumen changes of distal ICA before and after successful recanalization were analyzed. Results: Fifty-two patients who achieved successfully recanalization were studied. Based on the postoperative lumen diameter changes in the distal ICA, 19 cases were classified as distal-dilatation and the remaining 33 as distal-narrowness. Patients in the distal-narrowness group mostly had ICACO (21.1 vs. 54.5%) and were men (68.4 vs. 93.9%). In the distal-narrowness group, the lumen of the distal ICA recovered to normal in 32 of the 33 patients during the follow-up period. Of the 32 patients reviewed, the ICA of 28 patients dilated back to normal after 1 week of surgery; the ICA of remaining patients 4 dilated 2 weeks postoperatively. Conclusions: Narrowness of the distal ICA after hybrid recanalization was more prevalent in male patients with ICACO. Homogeneous stenosis of the whole course of the distal ICA is a low-perfusion narrowness which does not require intervention and will spontaneously recover after successful recanalization with an increase in the forward flow.
    Type of Medium: Online Resource
    ISSN: 1664-2295
    URL: Article
    DOI: 10.3389/fneur.2020.630028
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
    detail.hit.zdb_id: 2564214-5
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